Congestive Heart Failure in Women

Hear that rhythmic thump? Every beat of your heart pumps blood to cells throughout the body, delivering oxygen from the air you breathe and nutrients from the foods you eat.

Congestive heart failure prevents the heart from filling with enough blood, or pumping blood forcefully enough, to meet the needs of the body. This life-threatening health problem affects roughly 2.7 million American women. In right-sided heart failure, not enough blood gets pumped through the lungs to pick up oxygen. In left-sided heart failure, not enough oxygen-rich blood gets pumped to the rest of the body. Some women have both.

Struggling to do its job, the heart enlarges, says the American Heart Association. More muscle cells develop and the heart beats faster, too. Blood vessels throughout the body narrow, raising blood pressure to help compensate for power loss. The body shunts blood away from less essential organs to ensure that the brain and heart get sufficient supplies. Eventually, these strategies stop working as heart failure worsens.

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What are the symptoms?

  • Weakness and fatigue

  • Shortness of breath

  • Swollen ankles, feet and legs

  • Rapid or irregular heartbeat

  • Swelling of the abdomen (ascites)

  • Sudden weight gain

  • Persistent cough

  • Difficulty breathing when lying flat

What causes heart failure?

“Often, there’s more than one culprit,” explained Dr. Jan Cook, medical director of Blue Cross Blue Shield of Massachusetts. Untreated or poorly treated high blood pressure, a problem for nearly 40 percent of African American women, is the number one problem, according to the National Heart, Blood, and Lung Institute. Overweight and obesity, inactivity and high blood cholesterol — health issues affecting roughly 80 percent, 55 percent and 50 percent of African American women, respectively — raise odds for developing coronary artery disease (CAD) and heart attacks, another path to heart failure.

Does heart failure differ in women?

Generally, women develop heart failure later than men and live longer with it. Among women, high blood pressure and heart valve diseases are more likely than CAD to be underlying causes of heart failure. However, CAD is such a powerful risk factor that women who have it are much more likely to go on to develop heart failure than women who have only high blood pressure. Ankle swelling, breathlessness and curtailed ability to be active seem to affect women more often than men.

How is heart failure treated?

Experts recommend lifestyle changes, for example an exercise program prescribed by your doctor, plus medicines aimed at easing symptoms and preventing worsening heart failure, if possible. For example, diuretics remove excess fluid build-up and sodium from the body, thus lowering blood pressure. Other drugs called beta-blockers and ACE-inhibitors ease the heart’s workload in different ways. Medical devices to help the heart pump or surgery, such as coronary artery bypass, are sometimes needed, too.

Which lifestyle changes help prevent or ease heart failure?

Healthy habits can help prevent conditions that lead to heart failure or worsen it. Try tackling one change at a time. Blue Cross Blue Shield of Massachusetts members can use online tools at to set practical goals, create action plans and connect with experts.

  • Quit tobacco. That cuts your risk for CAD in half in one year. Get a step-by-step guide to quitting from (or 1-800-QUIT-NOW).

  • Exercise regularly. Regular exercise helps maintain a healthy weight, normal blood sugar and normal blood pressure.

  • Eat heart-healthy foods (see sidebar). This helps lower high cholesterol and high blood pressure.

  • Lose excess weight. This lightens the load on your heart and lowers risk for diabetes.

  • Keep blood pressure in a healthy range (below 140/90 mmHg.). Quitting smoking, exercising, losing extra pounds, easing stress and cutting down salt help you do so. Be sure to take medicine if prescribed.

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